Sofia Gourtsoyianni MD, Presenter: Nothing to Disclose

Giulia A. Zamboni MD, Abstract Co-Author: Nothing to Disclose

Janneth Yolanda Romero MD, Abstract Co-Author: Nothing to Disclose

Vassilios D. Raptopoulos MD, Abstract Co-Author: Research grant, Toshiba Corporation, Tustin, CA Research grant, E-Z-EM, Inc, Lake Success, NY

To evaluate the routine use of modified CT Enterography (CTE) in patients with acute abdominal pain in respect to intestinal detail along with conventional abdominal evaluation.

IRB approved this HIPAA-compliant retrospective study; informed consent was waived. Modified CTE exams of 100 consecutive patients with acute abdominal pain were reviewed. After ingestion as tolerated of 900–1200ml of 2% barium suspension +5ml of Gastrografin over 45 minutes and a split-bolus injection of 150ml of iv contrast (50ml 3 minutes pre-scan; then 100ml bolus) patients were scanned with 60s delay from the 2nd bolus on 64-row MDCT, with collimation of 0.75mm and 5mm axial, coronal and sagittal reformatted image display. Two radiologists reviewed axial, coronal and sagittal reformats and graded them on a 5-point scale (1=none to 5=excellent) in regard to contrast filling of the GI tract and parenchymal and vascular enhancement.

Compliance to oral contrast ingestion was variable: many patients had GI symptoms, with nausea and emesis, and all had various degrees of abdominal pain. Oral contrast reached the cecum in 71/100 patients. The ileocecal valve was identified in 72/98 patients (2 had previous surgery), the appendix in 56/92 (8 had previous appendectomy). Small bowel was well distended and opacified (medians=4). Mucosa detail was good (median=3): this correlated significantly (p<0.0001) with bowel opacification and distention in both jejunum and ileum. A combined nephrographic+excretory phase was achieved (medians 4 and 5, respectively). The great vessels were well opacified (mean aortic attenuation 191HU) allowing for vascular evaluation (median=5). Enhancement of the other abdominal structures was good with mean liver and splenic parenchyma attenuation of 106HU and 128HU, respectively. The cause of abdominal pain was identified in 47 patients (intestinal=33; extra-intestinal= 14).

Routine use of modified CTE is not challenging to acutely sick patients, and can be used as an efficient noninvasive exam informative of bowel, vessel and organ pathology

Modified CTE is an effective protocol in acute abdominal pain that can be used as a routine exam in the Emergency Department.

Gourtsoyianni, S, Zamboni, G, Romero, J, Raptopoulos, V, Routine Use of CT Enterography in Patients with Acute Abdominal Pain.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009356.html